Laser ablation for complete obstruction of bronchus—an anaesthetic challenge (two case report)

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Abstract

Background
Precise tissue destruction, minimal local inflammation and oedema with laser play useful role in the treatment of life-threatening paediatric airway lesions. Risk of fire in O-enriched atmosphere makes anaesthesia challenging. Fewer options are available for anaesthetic management of laser ablation for bronchial obstruction in children. Very few reports regarding the use of laser for bronchial obstruction in children are available.
Case presentation
Two paediatric patients admitted with difficulty in breathing and coughing. They were diagnosed having unilateral bronchial obstruction. They were posted for bronchoscopic laser ablation of blocked tissue. Anaesthesia was managed with total intravenous anaesthesia and ventilation through side arm of bronchoscope. Complications bleeding and pneumothorax happened in one child. Temporary rise in PaCO with fall in PH and PaO was also observed. Successful management is presented.
Conclusion
Careful preoperative evaluation, use of low Fio, measures to avoid fire hazards due to laser, monitoring SpO and EtCO and maintaining haemodynamic parameters play key role for successful management of laser for bronchial obstruction.

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